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Maintaining a healthy balance

With consumer interest high and changes in licensing of CBD products afoot, Sarah Clark explores developments in the health foods and supplements market

The UK CBD market is said to be worth £500m – a huge amount compared to staples such as vitamins C and D, which are reportedly worth £145m and £115m respectively.

Last year, the Food Standards Agency granted food supplement status to around 3,500 CBD products in a world first. 

Synthetic CBD manufacturer Pureis has recently been granted ethics approval to begin a phase III trial for the treatment of sleep disturbance using one of its products, with the company describing this as a crucial step towards achieving P medicine status in Australia first and then the UK. 

Pureis entrepreneur Lady Chanelle McCoy suggests that, in reality, there is still a long road to travel. Explaining current legislation, she says that CBD has been classed by the Food Standards Authority (FSA) as a novel food, meaning that to be licensed, it needs to have been through extensive phase I safety and toxicity studies. Once validated, it can remain on the UK market. “While the industry and pharmacists believed that this classification would lead to CBD products being properly regulated, in my opinion, that hasn’t been the case yet,” she says.

“I sympathise with pharmacies as it can be difficult to tell which CBD products are safe to recommend. The CBD market is still a grey area. The FSA has permitted around 12,000 CBD products to stay on the UK market while they’re under assessment, and hasn’t taken any off the market or granted any novel foods licences – we’re all in limbo.”

Steve Batchelor, marketing director for British Cannabis, says: “Pharmacists who are au-fait and confident with CBD products are in the minority. Fortunately, the number of pharmacists engaged in the category has been growing every year. Whilst we have worked as specialists in the pharmacy sector for over five years (and in particular the independent pharmacy sector, which Nielsen estimates makes up over three-quarters of all pharmacy CBD sales), we have seen pharmacists gradually getting used to the idea of cannabis-derived supplements. This has been driven both by advice from the NPA and MHRA, and the recently progressed FSA applications.”

Pureis was the first company to have its CBD products validated and was also the first to appear on the FSA list of novel foods. After speaking to the FSA in February, Lady McCoy says Pureis is likely to receive a novel foods licence, but will face lengthy waits.

She thinks the landscape for CBD may become even more confusing when the FSA does issue licences for CBD products and is faced with a difficult decision about taking unlicensed products off the market. “Pharmacies already struggle to know how and what to recommend,” she says. “If the FSA issues novel food licences to approved products and the rest are removed from market, pharmacists will have confidence that they are recommending safe and effective products, but I don’t see that happening for 12-18 months.”

A desire to learn

Lady McCoy believes pharmacists’ desire to learn more about the category can be hampered by a lack of confidence. “We understand that because CBD is a food supplement, it’s not possible to make specific health claims, making it harder for pharmacy teams, who need advice on how to manage that conversation,” she says.

The brand is keen to back up anecdotal reports with clinical evidence and plans to carry out a sleep disturbance study as part of its phase II and III studies. “We want to make the product available at a higher dose OTC, so we’re trying for a medicines licence,” says Lady McCoy. “We’re discussing the gaps in knowledge with the MHRA.”

Looking at the wider market, supplement sales boomed during the pandemic as health-conscious consumers sought to boost their immunity. According to the Health Food Manufacturer’s Association (HFMA), this upswing in sales seems unlikely to diminish any time soon, as habits formed during the pandemic appear to be sticking. 

HFMA executive director Graham Keen says: “Sales of natural health products, which mainly comprise vitamins and supplements, reached an all-time high in 2021. Lockdowns encouraged many people to consider and take up supplementation, and many consumers were increasingly recognising the value of investing in their health naturally. In addition to this, the Government gave priority status to high street health stores and the chain that feeds them (HFMA’s member companies) during lockdown, in recognition of the level of expertise available instore and the fact that natural health products play a key role in keeping the nation healthy.”

“The most up to date IRI sales data shows that VMS and nutrition products have maintained prominence in the consumer market, gained across the pandemic. To the week ending 22 January 2022, sales of natural health foods, vitamins and supplements were up nearly 20 per cent on their sales two years ago, pre-lockdown. The most recent data suggests a slowing down in the rate of this increase, but the numbers are still very positive... I certainly expect this upward trend to continue.” 

Susanne Haar, a pharmacist for Nelsons Pharmacy agrees that pharmacies should take supplements seriously, although quality is an important consideration. “I think we all agree that a healthy, balanced diet is a cornerstone of wellbeing,” she says, “but our environment and lifestyle can cause us to compromise sometimes. This is where high quality supplements that have been prepared using extracts tested to be highly absorbable will be of benefit.”

Vitamin D and BMI

Recent research has discovered that vitamin D metabolises differently in people who are overweight. Pharmacy teams should bear this in mind when approached by customers who have been told by their GP that they are deficient in the vitamin and want further advice. 

A study recently published in JAMA Network Open analysed data from VITAL, a clinical trial led by Brigham and Women’s Hospital, Boston. While researching whether supplementing with vitamin D or marine omega-3 supplements reduced the risk of developing cancer, heart disease or stroke, the researchers found that vitamin D supplementation correlated with positive effects on several health outcomes, but only among people with a BMI under 25.

Deirdre K. Tobias, associate epidemiologist in Brigham’s Division of Preventive Medicine says: “There seems to be something different happening with vitamin D metabolism at higher body weights, and this study may help explain diminished outcomes of supplementation for individuals with an elevated BMI.”

Iron supplements for women’s health

Women aged between 19 and 50 years require almost twice as much iron as men (14.8mg per day) due to the amount lost during menstruation. 

Women’s nutritional needs also change during menstruation, pregnancy, breastfeeding and menopause, so many could potentially benefit from an iron supplement to help them maintain their normal healthy iron levels.

Claire Campbell, brand manager for iron supplement brand BlueIron, suggests that the mineral is an important consideration for anyone asking for support for tiredness. She explains: “Whilst you can get a sufficient daily iron intake from a healthy and balanced diet with iron rich foods, almost a quarter (23 per cent) of the population take iron supplements. 

“Fatigue and unexplained tiredness are common during the menopause and are often attributed to fluctuating hormone levels. For this reason, iron supplements are popular with women going through the menopause as iron can help to reduce fatigue.”

Views from the P3pharmacy panel

CBD used to be an important sector for us, but in recent months, sales have dropped off rapidly as products are available in more outlets. The VMS category remains strong for us. Top sellers are Solgar, Nature’s Aid, Vitabiotics, Valupak and Floradix. We get lots of queries, especially about vitamin D. Customers want to know what strength they should take and how often they should take it. Vitamin B12 is another one we get asked about a lot, and iron. In winter, we get more requests for echinacea and vitamin C. Probiotics are a good seller, especially if a customer is taking antibiotics.

I think patients are paying more attention to vitamin deficiencies and trying to self treat with OTC medications. Customers ask us about what dosage level they should they be taking supplements at, how long they need to take them to notice a difference, and any side effects or interactions there may be with their regular medications. Good sellers for us include vitamin D preparations, gummies for kids and vitamin D drops. Advise staff to have charts available to show customers the recommended dosages of common vitamins and supplements.

We have historically stocked mainly a budget range of vitamins and supplements. However we are looking to change this. We don’t see much return custom by stocking such a range. The queries we get are mainly nutrition optimisation questions or for advice on supplementing treatment given by their GP. Our biggest selling product in this category is vitamin D. Awareness of vitamin D deficiency has increased in recent years. Building brand loyalty is very important to tackle the availability and accessibility of online health food shops. Adding advice is critical.

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